Date Posted
June 19, 2020
Full Time
Human Resources
More Information

Job Details

The Prior Authorization and Referral Specialist performs the following, according to established guidelines:  obtains precertification authorization from insurance companies for patients with scheduled surgical procedures, and various tests, including MRIs, CTs, and Sleep studies. In doing so, identifies and contacts patient’s insurance company for eligibility, pre-existing, and exclusions; provides patient’s medical history, treatments received, current conditions, and planned surgical treatment. Determines if prior approval is needed and notifies the appropriate department staff of outcome and the patient, when necessary.


Education: High school diploma or GED required. Must be able to speak, hear and understand the English language.

Experience: Minimum of 2 years computerized data entry experience required. Reception or clerical experience at a healthcare setting is preferred. Proficiency in use of Microsoft Office applications, specifically Word and Excel, e-mail, and internet/web searches is preferred.  Knowledge of computer to research, input, update information pertinent to specific tasks.   Interpersonal skills necessary in order to deal effectively with physicians, clinic personnel, insurance company representatives and patients in exchanging patient information to obtain precertification authorization.

Additional Skills and Abilities:  Knowledge of basic anatomy, physiology, coding and medical terminology in order to interpret patient history and treatments at a level normally acquired through completion of a one year medical assistant or medical secretary program.  Ability to concentrate and pay close attention to detail when reviewing patient medical record, insurance information, and entering data into the computer system which occupies approximately 75-80% percent of work time.

Contact Information

Apply on line at:

Questions contact Human Resources at 515-832-7711.

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